Date of Award

2009-08-01

Degree Name

PhD Nursing

Dissertation Committee

Anita J. Hunter, PhD, RN, CPNP, FAAN; Lois Howland, DrPH, RN; Mary-Rose Mueller, PhD, RN

Keywords

Diabetes self-management, Information-Motivation-Behavioral Skills Model, Mexican Americans, nursing, Psychometric testing, Type 2 Diabetes

Abstract

Background: The most successful diabetes self-management (DSM) programs focus on changing previously established behavior patterns. To develop focused and culturally appropriate self-management programs, health care providers need valid and reliable assessment tools. Purpose: To test the reliability and content and construct validity of an instrument developed to assess diabetes knowledge, motivation, and adherence to medical regimes. The Information-Motivation-Behavioral (IMB) Skills Diabetes scale was tested with 83 Mexican-American adults with type 2 diabetes from a community in Orange County, CA. Methodology: A cross-sectional correlational study design was conducted with 64 female and 19 male Mexican-American adults diagnosed diabetes type 2 patients. The participants completed a 101-item questionnaire comprised of a demographic section and 11 subscales for assessing diet and exercise knowledge, attitudes, motivational factors, and diabetes behavioral skills. The questionnaire concluded with seven short-answer questions to assess content validity of the instrument. Data Analysis: Descriptive statistics, correlations, and multiple regression analyses were used. Results: Participants had a low literacy level which affected their ability to read food labels, count carbohydrates, and understand information taught in diabetic education classes. They tended to have strong family support systems but poor internal motivation. Based on Cronbach's alpha reliability coefficient values, only seven of the 11 subscales were considered reliable. Gender differences were not significant except in one case: women scored higher in exercise behavior. Participants who read food labels and followed their dietary plan were more likely to have lower HbA1c values. Over 67% of all participants had suboptimal HbA1c levels and women had the highest percentage of abnormal HbA1c scores, even though they had indicated they were more likely to read food labels and follow their dietary plans. Conclusions: The IMB scale demonstrated adequate item reliability, but poor ability to assess diabetes type 2 adherence with this population. These results have relevance to caring for Mexican-American diabetic patients and emphasizes the importance of culturally relevant nutritional intake and exercise expectations. Providers need to foster the development of their patients' internal personal motivators.

Document Type

Dissertation: Open Access

Department

Nursing

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